Nutrición enteral precoz en el paciente con lesiones complejas

Wilfredo Hernández Pedroso, Ernesto Chávez Rodríguez

Texto completo:

PDF

Resumen

El interés de introducir nuevas pautas terapéuticas en la atención del paciente con lesiones complejas ha motivado el estudio y desarrollo de esquemas novedosos de apoyo metabólico y nutricional. En los últimos años se ha podido comprobar que el paradigma de la Nutrición enteral precoz mejora el pronóstico de los pacientes con lesiones complejas. Las experiencias acumuladas en Cuba con esta modalidad de apoyo nutricional son escasas. Es por esta razón que se presenta esta revisión sobre las características de la Nutrición enteral precoz, y las ventajas y desventajas esperadas de la aplicación de la misma. Se mencionan las experiencias extraídas de ensayos clínicos y estudios experimentales. Se concluye que la Nutrición enteral precoz ha mostrado ventajas importantes en la evolución de los pacientes con lesiones complejas, entre las que se pueden mencionar la disminución de la morbi-mortalidad, la reducción de la estadía hospitalaria, y el acortamiento del tiempo de ventilación mecánica. Como es de esperar, todas estas bondades traen consigo una disminución destacada de los costos hospitalarios. Si bien la implementación de los esquemas de Nutrición enteral precoz puede requerir de recursos materiales y humanos, el costo de instalación de los mismos no empaña los beneficios tangibles que se obtienen en la evolución del paciente con lesiones complejas.

Palabras clave

Nutrición; Nutrición enteral; Lesiones complejas; Nutrición enteral precoz

Referencias

Heyland DK. Nutritional support in the critically ill patients. A critical review of the evidence. Crit Care Clin 1998;14: 423-40.

Dinarello CA. Proinflamatory cytokines. Chest 2000;118:503-8.

Pawloski W, Kos A, Szczygiel B. Parenteral nutrition in postoperative period. Pol Merkuriusz Lek 1998;4:186-9.

Aznarte Padial P, Pareja Rodríguez de Vera A, de la Rubia Nieto A, López Soriano F, Martínez de Guzmán M. Impact of hospitalization on patients with nutrition status evaluation at admission. Nutr Hosp [España] 2001;16:14-8.

Hoffer LJ. Protein and energy provision in critical illness. Am J Clin Nutr 2003; 78:906-11.

Krishnan JA, Parce PB, Martínez A, Diette GB, Brower RG. Caloric intake in medical ICU patients: Consistency of care with guidelines and relationship to clinical outcomes. Chest 2003;124:297-305.

Aguilar Salinas CA. La regulación hormonal del catabolismo de las proteínas. El papel del glucagon y la proteína de la soya. Rev Invest Clin 2003;55:84-6.

Biffl WL, Moore EE, Haenel JB. Nutrition support of the trauma patient. Nutrition 2002;18:960-5.

Slone DS. Nutritional support of the critically ill and injured patient. Crit Care Clin 2004;20:135-57.

Bouffandeau B. Impact: from nutrition to drug. Press Med 2000;29:98-9.

de Witt RC, Kudsk KA. Enteral nutrition. Gastroenterol Clin North Am 1998;27:371-86.

Wray CJ, Mammen JM, Hasselgren PO. Catabolic response to stress and potential benefits of nutrition support. Nutrition 2002;18:971-7.

Kiyama T, Efron DT, Tantry U, Barbul A. Trauma and wound healing: role of the route of nutritional support. Int J Surg Investig 2001;2:483-9.

Serpa LF, Kimura M, Faintuch J, Ceconello I. Effects of continuous versus bolus infusion of enteral nutrition in critical patients. Rev Hosp Clin Fac Med Sao Paulo 2003;58:9-14.

Carlin CB, Scanlon PH, Wagner DA, Borghesi L, Geiger JW, Long CL. Gastric emptying in trauma patients. Dig Surg 1999;16:192-6.

Kao CH, ChangLai SP, Chieng PU, Yen TC. Gastric emptying in head-injured patients. Am J Gastroenterol 1998;93: 1108-12.

Costa M, Wattchow D, Brookes S. Neuronal control in gastrointestinal disease. Eur J Surg Suppl 2002;587: 39-46.

Marino LV, Kiratu EM, French S, Nathoo N. To determine the effect of metoclopramide on gastric emptying in severe head injuries: A prospective, randomized, controlled clinical trial. Br J Neurosurg 2003;17:24-8.

Heyland DK, McDonald S, Keefe L, Drover JW. Total parenteral nutrition in the critically ill patients: A meta analysis. JAMA 1998;280:2013-9.

Moore FA. Common mucosal immunity: a novel hypothesis. Ann Surg 2000;231: 9-10.

Jeschke MG, Debroy MA, Wolf SE, Rajaraman S, Thompson JC. Burn and starvation increase programmed cell death in small bowel epithelial cells. Dig Dis Sci 2000;45:415-20.

Shanahan F. Gut flora in gastrointestinal disease. Eur J Surg Suppl 2002;47-52.

Sakamoto K, Hirose H, Ezaki T, Kawamura Y, Onizuka A, Hayashi M; et al. Translocation of Salmonella typhimurium in rats; effect of enteral and parenteral nutrition. Eur J Surg 2000;166:814-7.

Bastian L, Weimann A. Practical aspects of early enteral feeding. Anaesthesiol Reanim 1999;24:95-100.

Johnson D, Mayers I. Multiple organ dysfunction syndrome: a narrative review. Can J Anaesth 2001;48:502-9.

Choudhry MA, Haque F, Khan M, Fazal N, Al-Ghoul W, Ravindranath T; et al. Enteral nutrition supplemmentation prevents mesenteric lymph node T-cell suppression in burn injury. Crit Care Med 2003;31:1764-70.

Raff T, Hartmann B, Germann G. Early intragastric feeding of seriously burned and long-term ventilated patients: A review of 55 patients. Burns 1997;23: 19-25.

Omura K, Hirano K, Kanehira E, Kaito K, Tamura M, Nishida S; et al. Small amount of low-residue diet with parenteral nutrition can prevent decreases in intestinal mucosal integrity. Am Surg 2000;231:112-8.

Chan S. McCowen KC. Blackburn GL. Nutrition management in the ICU. Chest 1999;115(5 Suppl):145S-148S.

McClave SA, Maresano LS, Lukan JC. Enteral access for nutritional support: rationale for utilization. J Clin Gastroenterol 2002;35:209-13.

Tugrul S, Selcukoglu E, Ozcan PE, Akinci O, Esen F, Telci L; et al. Is jejunal feeding efficient in critically ill patients? Ulus Travma Derg 2002;8: 16-21.

Mesejo A, Juan M, García Simón M. Enteral access and intestinal function assessment in the critically ill patient. Nutr Hosp [España] 2007;22(Suppl 2): 37-49

Berne JD, Norwood SH, McAuley CE, Vallina VL, Villareal D, Weston J; et al. Erythromycin reduces delayed gastric emptying in critically ill trauma patients: A randomized, controlled trial. J Trauma 2002;53:422-5.

Boulanger BR, Brennemann FD, Rizoli SB, Nayman R. Insertion of a transpyloric feeding tube during laparotomy in the critically injured: rationale and plea for routine use. Injury 1995;26:177-80.

Shang E, Kähler G, Meier-Hellmann A, Scheele J. Advantages of endoscopic therapy of gastrojejunal dissociation in critical care patients. Intensive Care Med 1999;25:162-5.

Berger MM, Werner D, Revelly JP, Cayeux MC, Tappy L, Bachmann C; et al. Serum paracetamol concentration: an alternative to X-rays to determine feeding tube location in the critically ill. JPEN J Parent Enteral Nutr 2003;27:151-5.

Kortbeek JB, Haigh PI, Doig C. Duodenal versus gastric feeding in ventilated blunt trauma patients: a randomized controlled trial. J Trauma 1999;46:992-6.

Ledeboer M, Masclee AA, Coenraad M, Vecht J, Biemond I, Lamers CB. Antroduodenal motility and small bowel transit during continuous intraduodenal or intragastric administration of enteral nutrition. Eur J Clin Invest 1999;29: 615-23.

Holmes JH 4th, Brundage SI, Yuen P, Hall RA, Maier RV, Jurkovich GJ. Complications of surgical feeding jejunostomy in trauma patients. J Trauma 1999;47:1009-12.

Zapas JL, Kanakozis S, Kirkpatrick JR. Prophylactic jejunostomy: a reappraisal. Surgery 1998;124:715-9.

Nguyen NT, Schauer PR, Wolfe BM, Ho HS, Luketich JD. Laparoscopic needle catheter jejunostomy. Br J Surg 2000;87:482-3.

Barrera R, Schattner M, Nygard S, Ahdoot M, Ahdoot S, Adeyeye S, Groeger J; et al. Outcome of direct percutaneous endoscopic jejunostomy tube placement for nutritional support in critically ill, mechanically ventilated patients. J Crit Care 2001;16:178-81.

De Vivo P, Mastronardi P, Ciritella P, Del Gaudio A, Marzano TF, De Razza L; et al. Early percutaneous endoscopic gastrostomy (PEG). A safe and effective enteral feeding technique in neurologic intensive care unit. Minerva Anestesiol 1996;62:197-201.

DiLorenzo, Dalton B, Miskovitz P. Percutaneous endoscopy gastrostomy. What are the benefits, what are the risks? Postgrad Med 1992;91:277-81.

Boivin MA, Levy H. Gastric feeding with erythromycin is equivalent to transpyloric feeding in the critically ill. Crit Care Med 2001;29:1916-9.

Tejada Artigas A, Bello Dronda S, Chacón Vallés E, Muñoz Marco J, Villuendas Usón MC, Figueras P; et al. Risk factors for nosocomial pneumonia in critically ill trauma patients. Crit Care Med 2001;29:304-9.

Heyland DK, Cook DJ, Dodek PM. Prevention of ventilator-associated pneumonia: current practice in Canadian intensive care units. J Crit Care 2002;17:161-7.

Neumann DA, DeLegge MH. Gastric versus small-bowel tube feeding in the intensive care unit: a prospective comparison of efficacy. Crit Care Med 2002;30:1436-8.

Adams S, Dellinger EP, Wertz MJ, Oreskovich MR, Simonowitz D, Johansen K. Enteral versus parenteral nutrition support following laparotomy for trauma: a randomized prospective trial. J Trauma 1986;26:882-91.

Moore FA, Moore EE, Kudsk KA, Brown RO, Bower RH, Koruda MJ; et al. Clinical benefits of an immune-enhancing diet for early postinjury enteral feeding. J Trauma 1994;37: 607-15.

O’Flaherty L, Bouchier-Hayes DJ. Immunonutrition and surgical practice. Proc Nutr Soc 1999;58:831-7.

Houdijk AP, van Leeuwen PA. Glutamine-enriched enteral nutrition in multiple trauma patients. Nutrition 2000;16:70-1.

Carroll PV, Jackson NC, Russell-Jones DL, Treacher DF, Sönksen PH, Umpleby AM. Combined growth hormone/insulin-like growth factor I in addition to glutamine-supplemented TPN results in net protein anabolism in critical illness. Am J Physiol Endocrinol Metab 2004;286:E151-7.

Boelens PG, Houdijk AP, Haarman HJ, Nijveldt RJ, van Leeuwen PA. Glutamine-enriched enteral nutrition decrease infectious complications in trauma patients. Am J Clin Nutr 2002;76:253-4.

Montejo JC, Zaragoza A, López Martínez J, Urrutia G, Roqué M, Blesa AL, Celaya S; et al. Immunonutrition in the intensive care unit. A systemic review and consensus statement. Clin Nutr 2003;22:221-33.

Fuch Tarlovsky V. Alimentación por vía enteral. Importancia en la práctica clínica. Rev Gastroenterol Mex 1999; 64:95-102.

De Vree JM, Romijn JA, Mok KS, Mathus-Vliegen LM, Stoutenbeek CP, Ostrow JD; et al. Lack of enteral nutrition during critical illness is associated with profound decrements in biliary lipid concentrations. Am J Clin Nutr 1999;70:70-7.

Moore EE, Jones TN. Benefits of immediate jejunostomy feeding after major abdominal trauma- a prospective, randomized study. J Trauma 1986;26: 874-81.

Beier-Holgersen R, Boesby S. Effect of early postoperative enteral nutrition on postoperative infections. Ugeskr Laeger 1998;160:3223-6.

Beier-Holgersen R, Boesby S. Influence of postoperative enteral nutrition on postsurgical infections. Gut 1996;39: 833-5.

Chuntrasakul C, Siltharm S, Chinswangwatanakul V, Pongprasobchai T, Chockvivatanavanit S, Bunnak A. Early nutritional support in severe traumatic patients. J Med Assoc Thai 1996;79:21-6.

Wang S, Wang S, You Z. Clinical study of the effect of early enteral feeding on reducing hypermetabolism after severe burns. Zhonghua Wai Ke Za Zhi 1997;35:44-7.

Wang S, Wang S, Li A. A clinical study of early enteral feeding to protect the gut function in burned patients. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1997;13:267-71.

Taylor SJ, Fettes SB, Jewkes C, Nelson RJ. Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Crit Care Med 1999;27:2525-31.

Adams GF, Guest DP, Ciraulo DL, Lewis PL, Hill RC, Banker DE. Maximizing tolerance of enteral nutrition in severely injured trauma patients: a comparison of enteral feeding by means of percutaneous endoscopic gastrostomy versus percutaneous endoscopy gastrojejunostomy. J Trauma 2000;48:459-64.

Yanagawa T, Bunn F, Roberts I, Wentz R, Pierro A. Nutritional support for head-injured patients. Cochrane Data-base Syst Rev 2002:CD001530.

Suchner U, Senftleben U, Eckart T, Scholz MR, Beck K, Murr R; et al. Enteral versus parenteral nutrition: Effects on gastrointestinal function and metabolism. Nutrition 1996;12:13-22.

Braga M, Gianotti L, Vignali A, Cestari A, Bisagni P, Di Carlo V. Artificial nutrition after major abdominal surgery: impact of route of administration and composition of the diet. Crit Care Med 1998;26:24-30.

Bastian L, Weimann A, Bischoff W, Meier PN, Grotz M, Stan C; et al. Clinical effects of supplemental enteral nutrition solution in severe polytrauma. Unfallchirurg 1998;101:105-14.

Kiyama T, Efron DT, Tantry U, Barbul A. Effect of nutritional route on colonic anastomotic healing in the rat. J Gastroent Surg 1999;3:441-6.

Peng X, Feng J, Wang S. Effects of early enteral feeding on nitric oxide synthase activity in small intestine in burned rat. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1998;14: 37-40.

Wang F, Wang S, Zhao Y, You Z, Wang P, Vallete A. The influence of different nutritional support routes on the intestinal mucosal epithelial cell cycle in burned rats. Zhonghua Shao Shang Za Zhi 2002;18: 203-6.

Silk DB, Gow NM. Postoperative starvation after gastrointestinal surgery. Early feeding is beneficial. BMJ 2001;323:761-2.

Marvin RG, McKinley BA, McQuiggan M, Cocanour CS, Moore FA. Non-oclussive bowel necrosis occurring in critically ill trauma patients receiving enteral nutrition manifests no reliable clinical signs for early detection. Am J Surg 2000;179:7-12.

Mc Clave SA, Mallampalli A. Nutrition in the ICU, part 2: Enteral feeding - candidates and complications. J Crit Illness 2001;16:248-54.

Khaodhiar L, Bistrian BR. Total parenteral nutrition for critically ill patients. JAMA 1999;282:1423-4.

Guidroz AD, Chaudhary AJ. Enteral access in mechanically ventilated patients. Nutr Clin Pract 2004;19:610-21.

Lewis SJ, Egger M, Sylvester PA, Thomas S. Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 2001;323:773-6.

Minard G, Kudsk KA. Early versus delayed feeding with an immune-enhancing diet in patients with severe head injuries. JPEN J Parent Enteral Nutr 2000;24:145-9.

Michel KE. Preventing and managing complications of enteral nutritional support. Clin Tech Small Anim Pract 2004;19:49-53.

Montejo JC, Jiménez J, Ordóñez J, Caparros T, García A, Ortiz C; et al. Complicaciones gastrointestinales de la nutrición enteral en el paciente crítico. Med Intensiva 2001;25:152-60.

Serón Arbeloa C, Avellanas Chavala M, Homs Gimeno C, Larraz Vileta A, Laplaza Marín J. Análisis descriptivo del soporte nutricional en una UCI polivalente. Complicaciones de la nutrición enteral. Nutr Hosp [España] 1999;14: 217-22.

Engel JM, Muhling J, Junger A, Menges T, Karcher B, Hempelmann G. Enteral nutrition practice in a surgical intensive care unit: what proportion of energy expenditure is delivered enterally? Clin Nutr 2003;22:187-92.

Reignier J, Thenoz-Jost N, Fiancette M, Legendre E, Lebert C, Bontemps F ; et al. Early enteral nutrition in mechanically ventilated patients in the prone position. Crit Care Med 2004;32: 94-9.

Enlaces refback

  • No hay ningún enlace refback.




Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.